Participants in the BLSA aged 60 and older were examined to detect changes in psychological, neurological, and neuropsychological tests related to early signs of Alzheimer's disease (AD) . Six-year changes in immediate visual memory performance assessed by the Benton Visual Retention test were used to predict AD prior to its onset and 6-15 and 16-22 year subsequent cognitive performance. Subjects with diagnoses of AD had larger changes in immediate memory performance over the six-year interval prior to the estimated onset of their disease than subjects without AD. Six-year longitudinal change in immediate visual memory performance also predicted 6-15 and 16-22 year subsequent cognitive performance, even after adjusting for the influences of age, general ability, and initial immediate memory. These results provide evidence that change in immediate visual memory performance has long-term prognostic significance over as many as 16-22 years.